Practical information about medications for people living with diabetes.
Author: drmandyreece1
Hi, I'm Mandy. I am a pharmacist and certified diabetes educator. I love working with patients with diabetes with the goal of empowering people living with diabetes to have the best quality of life.
Insulin pricing and cost is at the front of everyone’s mind these days in the diabetes world. FDA is transitioning certain biologic products (i.e. insulin) which are currently regulated under the Federal Food, Drug and Cosmetic Act to be licensed as biologics under the Public Health Service Act. This is a game changer because it will biosimilar insulins to come to market for the first time. Ideally, this competition will help drive down insulin costs. Time will tell.
While the battle over insulin costs continue to wage, Express Scripts is lowering monthly cap for insulin copayments to $25. For a typical patient insured by Cigna or Express Scripts average out-of-pocket cost per month for insulin in 2018 was $41.50. Those in high-deductible health plans paid an average of about $100 for each monthly prescription. The challenge is that the health plan sponsors (i.e. employers) will have to opt-in to an out-of-pocket cap program in order for patients to benefit from it.
While this is certainly a step in right direction, the challenge of insulin cost remains. On a positive note, the U.S. Senate Finance Committee is currently investigating insulin pricing. Within the last week, leading physicians who are expert in diabetes testified regarding this insulin pricing crisis.
LibreLinkUp, remote monitoring app for FreeStyle Libre, is
now available in U.S. In fall of 2018,
the FreeStyle LibreLink iphone scanning app was released. This new remote monitoring app works with the
FreeStyle LibreLink iPhone app (use to scan to the sensor) to allow parents and
caregivers to remotely view glucose trends in real time within LibreLinkUp app.
To learn more, please click below, and make sure to download this new app from
the app store.
I recall fondly meeting Barbara for the first time just a few years ago while I was providing diabetes education services with a local physician group. Barbara was at wits end with her diabetes and struggling with momentum to keep the self-management up with all of her “other” life responsibilities. When I shared with Barbara that I was a pharmacist and diabetes educator, she seemed a bit confused, as often happens, as she had not met a pharmacist who was a diabetes educator before. I took some time to share how pharmacists work with persons with diabetes all the time. So, what are pharmacists, where can you find pharmacist, and how can they work with you in managing your diabetes?
The old joke that pharmacists simply count by 5, put pills in a bottle and give the bottle to the patient is not true. Pharmacists are truly the medication experts. Pharmacists complete rigorous training in anatomy and physiology of human body, and pharmacology, medicinal chemistry and therapeutics of medications plus many additional courses. Today, all pharmacists graduating from pharmacy school earn a Doctor of Pharmacy (PharmD) degree. You will find pharmacists in community pharmacies, physician offices, clinics, pharmaceutical companies, hospitals (on the various floors and in emergency room), insurance companies, nursing homes and many other settings. The specific job responsibilities will vary depending on setting.
So how can pharmacist in community pharmacy or physician’s office (clinic) work with you to assist you self-management of your diabetes? Pharmacists can provide in depth counseling about your medications, such as how they work, any potential side effects, assess for drug interactions, how to administer insulin. Your Pharmacist can perform an annual or even quarterly medication reviews to assist in the selection of medications based on formulary (your insurance company’s list of preferred medications). Pharmacists who have advanced diabetes training can offer in depth diabetes education for those newly diagnosed or simply needing a yearly refresher, assist you in selection of continuous glucose monitor or insulin pump and provide focused ongoing support for diabetes self-management. Pharmacists can also provide your annual influenza vaccine as well as additional vaccines such as pneumococcal, singles and Hepatitis B (state laws vary in regard to pharmacist administration of vaccines).
Back to Barbara…Barbara needed ongoing support and a sounding board to manage the challenges of life that created many obstacles in her diabetes self-management. In addition to being her sounding board, I also collaboratively managed her medication regimen with her and her physician. It was truly a partnership. My life is forever changed through the many partnerships that I have formed with persons living with diabetes. I encourage you to get to know your pharmacist as they are a great asset and support system in living with diabetes.
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Metformin has been shown to have to reduce risk of developing type 2 diabetes in those with prediabetes for the last 15 years. Metformin has been proven safe with the added bonus of being inexpensive. Diabetes Prevention Program which began over 15 years ago randomized 3234 participants age 25 and older who were high risk for developing type 2 diabetes to intensive lifestyle modification, metformin or placebo. Metformin was the superior treatment. For those who were randomized to metformin, they were able to continue metformin during the observational follow up study (Diabetes Prevention Program Outcomes Study — DPPOS). Incidence of type 2 diabetes was statistically lower in those taking metformin versus placebo when using fasting and 2 hour glucose tolerance test or hemoglobin A1c test. Please click on the link to below to read more about the findings from DPPOS.
http://care.diabetesjournals.org/content/42/4/601
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#metformin #preventing #type2 #diabetes
Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.
The ADA 2019 Standards of Care is now a living document, Living Standards of Care, which provides updates in real time rather than every 12 months. Sections 9 – 11 have been updated with data from Dapagliflozin (Farxiga) Effect on Cardiovascular Events -Thrombosis in Myocardial Infarction 58 (DECLARE-TIMI 58) trial. These sections now incorporate Farxiga’s benefit on heart failure hospitalizations and CDK progression, and safety in moderate renal impairment. Section 10 has been updated with findings from Reduction of Cardiovascular Events with Icosapent Ethyl (Vascepa)-Intervention Trial (REDUCE-IT). ADA recommends Vascepa for triglyceride lowering in persons with diabetes and high atherosclerotic cardiovascular disease risk. To learn more, please click on link below.
Semaglutide, an injectable glucagon-like peptide 1 (GLP-1) receptor agonist is being studied in an oral formulation for type 2 diabetes — first oral formulation of GLP-1 agonist. A series of 10 trials, PIONEER, on oral semaglutide have been conducted over last several years. Within the last week, the results of PIONEER-3 trial were presented. In this trial, 1864 adults with type 2 diabetes and A1c 7 – 10.5% (even with use of metformin with or without sulfonylurea) were randomized to three doses (3 mg, 7 mg or 14 mg) of oral semaglutide or 100 mg sitagliptin (Januvia). As expected, significantly more gastrointestinal adverse effects occurred with 14 mg oral semaglutide. A1c reduction and weight reduction were significantly greater for 7 mg and 14 mg or oral semaglutide as compared to sitagliptin. To learn more about these findings, please click below.
The Endocrine Society has released new diabetes guidelines for older adults. These guidelines provide great insight into the uniqueness of providing diabetes care for this special population with a focus on shared decision making and individualized treatment goals, treatment of co-morbidities (hypertension and dyslipidemia) and impact co-morbidities such as renal impairment and heart disease have on medication selection. Lastly, emphasis on identifying and addressing prediabetes in older adults. To learn more about these new guidelines, please click below.
When I first read about an app that detects diabetes, I must admit that I was skeptical. The app, Azumio Instant Heart Rate, uses smartphone based photoplethysmography (PPG) to detect diabetes. The contact PPG (using fingertip scan) was used to obtain waveforms of color changes in blood vessels with heart beat to develop the screening test. Further research is being conducted to see how PPG signal detected diabetes compares with diabetes detected from blood glucose or hemoglobin A1c. The app is a screening not diagnosis tool so healthcare provider would need to confirm the findings. To learn more about this interesting app, please click below.
Type 2 diabetes can be prevented yet the journey of prevention is challenging. Making changes to our nutritional habits and physical activity are two keys for type 2 diabetes prevention. When it comes to physical activity, cardiovascular exercises such as walking, running, bike riding are often emphasized more than resistance training. Well as it turns out muscle strength should also be considered. In a prospective health outcomes study, moderate muscle strength was actually associated with 32% reduction in incidence of type 2 diabetes when compared to those with lower muscle strength. These findings sure motivate me to rise early in the morning to head to gym for my usual Wednesday morning workout which happens to include weights. To learn about about this study, please click below.
